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COASTAL PHARMACY, INC.
HV00089B Chatham County Board of Health
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Covered Entity Details
Entity Name
Chatham County Board of Health
Subdivision Name
Liberty CARE Center
Type
Ryan White Part C
340B ID
HV00089B
Entity Address
Liberty CARE Center
1113 East Oglethorpe Hwy
Hinesville, GA 31313
Grant Number
H76HA00089
Participating Start Date
7/1/2017
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
COASTAL PHARMACY, INC.
Pharmacy Address
D/B/A HINESVILLE PHARMACY
481 ELMA G MILES PKWY
HINESVILLE, GA 31313-4006
Pharmacy Comments
Contract Details
Approval Date
10/8/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Susan Alt, Health Informatics
(912) 651-0995
Contract Pharmacy Representative
Coastal Pharmacy, Inc. dba Hinesville Pharmacy
Alex Tucker, Vice-President
(912) 876-8125
Signed By Date
10/8/2021
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